CHRONIC FACTORS

1
DRAFT1 ALGORITHM TO DISCUSS EOL PLANNING IN
HOSPITAL

• EMERGING OPINION OVER TIME OF LIKELY
• Disease trajectory
• margins of uncertainty over best and worst
  prognosis
• At risk of losing capacity

2b
2c

• LOG what
• Was said
• Was not said
• To the patient

PALLIATIVE CARE ADVICE OR SUPPORT?

• COMMUNICATE WITH
• your team
• Primary Care

2d
2e
2a
DISCUSS WITH GP WHO, WHEN AND HOW one should be
introducing this to the patient

• LOG the development of
• disease markers
• your views

REGULAR REVIEW REVISION
CHRONIC FACTORS
ACUTE FACTORS
TIMING (MARGINS OF PROGNOSTIC CERTAINTY?)
DISCUSSION NEEDED?
GENERAL
INCIDENTAL
WIDE e.g. gt 6 months
?

• PATIENT INITIATION
• SURPRISE QUESTION
• CLINICAL INDICATORS
• Weight loss gt10
• Karnofsky lt50
• Albumin lt25
• Gen. Phys. Decline

• severity?
• reversibility?
• Assoc.organ failure?

?
NARROW e.g. lt 6 weeks
?
ASSESS CAPACITY, PLAN CONTENT, DELIVER RECORD
DISEASE SPECIFIC
DISEASE SPECIFIC

• EXAMPLES
• Multiple mets (brain, liver or lung)
• Refractory hypercalcaemia
• Tumour Bleeding,
• Bone marrow failure

• EXAMPLES
• Multiple mets (brain, liver or lung)
• Refractory hypercalcaemia
• Tumour Bleeding,
• Bone marrow failure

• CANCER
• Metastases?
• Rx resistence?

ADVANCED CARE PLANNING
ESSENTIAL and URGENT

• EXAMPLES
• Repeated hospital admissions
• requiring inotropic support
• Progressive renal insufficiency
• Respiratory failure
• Discontinuation of dialysis
• Severe hyperkalaemia without treatment

validated markers (overleaf) Actively explore
plans and aspirations Seek appropriate
opportunity to begin introducing ideas of an
uncertain future,
PRUDENT and TIMELY
ACTIVELY DYING? ? LCP

• EXAMPLES
• Repeated hospital admissions
• Sepsis, bedridden
• Any coma where fluids are not given

FRAILTY